Patient recall of specific cognitive therapy contents predicts adherence and outcome in adults with major depressive disorder

Abstract

The current study examined whether and which specific contents of patients’ memory for cognitive therapy (CT) were associated with treatment adherence and outcome. Data were drawn from a pilot RCT of forty-eight depressed adults, who received either CT plus Memory Support Intervention (CT + Memory Support) or CT-as-usual. Patients’ memory for treatment was measured using the Patient Recall Task and responses were coded into cognitive behavioral therapy (CBT) codes, such as CBT Model and Cognitive Restructuring, and non-CBT codes, such as individual coping strategies and no code. Treatment adherence was measured using therapist and patient ratings during treatment. Depression outcomes included treatment response, remission, and recurrence. Total number of CBT codes recalled was not significantly different comparing CT + Memory Support to CT-as-usual. Total CBT codes recalled were positively associated with adherence, while non-CBT codes recalled were negatively associated with adherence. Treatment responders (vs. non-responders) exhibited a significant increase in their recall of Cognitive Restructuring from session 7 to posttreatment. Greater recall of Cognitive Restructuring was marginally significantly associated with remission. Greater total number of CBT codes recalled (particularly CBT Model) was associated with non-recurrence of depression. Results highlight the important relationships between patients’ memory for treatment and treatment adherence and outcome.

Memory performance predicts response to psychotherapy for depression in bipolar disorder: A pilot randomized controlled trial with exploratory functional magnetic resonance imaging

“…The finding that patients with better verbal retention and recognition showed greater improvement in depressive symptoms in CBT and SP is consistent with findings in major depression (10). Of note, poor verbal recall has also been linked to recurrence of mania following supportive psychotherapy for relapse prevention in bipolar disorder (47).…”

“…From this perspective, psychotherapy relies on patients' memory to exert its therapeutic effects (9). For instance, in unipolar depression, deficits in memory (10, 11) and executive function (12) have been linked with poorer CBT treatment outcome. There is similar evidence for elderly adults with generalized anxiety disorder treated with CBT (13, 14).…”

Patient Memory for Psychological Treatment Contents: Assessment, Intervention, and Future Directions for a Novel Transdiagnostic Mechanism of Change

“…While this counting method of measuring patient recall shows evidence of reliability and validity (Harvey et al, 2016; J.Y. Lee & Harvey, 2015), there may be important differences in the quality, importance, or impact of recalled treatment points (Dong, Zhao, Ong, & Harvey, 2017). Moreover, we do not know the extent to which free recall relates to the utilisation of treatment points in daily life situations.…”

“…On the other hand, greater recall is associated with better therapist and patient ratings of treatment adherence in cognitive therapy for depression (Dong, Lee, & Harvey, 2017a), and treatment adherence has been linked in turn to better outcomes (Taylor, Abramowitz, & McKay, 2012). Additionally, patients receiving cognitive therapy for depression who recall the process of cognitive restructuring are more likely to show a good response to treatment (Dong et al, 2017). In a recently completed study, participants who recalled more treatment points from an online intervention to reduce procrastination showed greater change in key mechanisms of procrastination one week later (Zieve & Harvey, 2018b).…”

“…Finally, the relationship between recall and outcome may depend on the timing relative to treatment. Studies investigating memory for treatment contents and outcome during treatment have generally found significant relationships between these variables (Dong, Lee et al, 2017a; Dong, Zhao et al, 2017; J.Y. Lee & Harvey, 2015).…”